10039903_MCM_OCT2021

My Wellness

What the Heck is onychomycosis? BY DAVID T. TAYLOR, DPM, FACFAS

Mycotic (fungal) toenail infections are a common condition. In fact, most people over 75 years of age have some degree of infection. The fungal organisms that cause toenail infections are common. The spores responsible can be found in your shoes, in the soil and basically everywhere on the Earth. The thought is that the longer you’re on the Earth, the better your chance of developing an infection. The same fungal or ganisms that cause nail infections also cause infections of the skin, scalp and other parts of the body. The thickening and discolor ation can vary in the number of toenails affected and the severity of the infection. The great toe and fifth toe are typically the most symptomatic, followed by the second, third and fourth toes. Infections range from totally

pain-free to severely painful. Pressure on the toe(s) from poorly fitting shoes will make the affected nail more painful. Thickened toenails may become ingrown, or fluid can develop and be trapped beneath the nail. Diagnosis of a fungal nail infection is generally based upon clinical judgement. Other conditions can cause thickening and discoloration of the toenail, such as repetitive trauma, pso riasis, acrylic nail applications and pigments from nail polish es. Mild discoloration and thick ening that does not respond to topical medication may benefit from a toenail culture and PAS/ KOH stain to determine treat ment. A fungal PCR test is avail able; however, the test is expen sive and almost never changes the treatment. Finally, despite a strong clinical presentation of a fungal toenail, the tests to

detect fungal elements within the nail plate are often negative. If you have a thickened and discolored toenail, I suggest ap plying a topical antifungal daily for at least six months, as it takes up to 12 months for a toenail to fully grow out. I suggest you take a “before treatment” picture with your cell phone so you can track the improvement. An abundance of topical items for treating the condition are endorsed on various social media platforms. I recommend tried and true antifungals that are reasonably priced. Please refrain from soaking your feet in bleach or any caustic solutions, as these are damaging to your skin and have not proven to be effective. A variety of over-the-counter (OTC) and prescription prod ucts are available for treating fungal nails. Topical medicine generally works in mild cases and has little to no side effects – they can prevent more severe infections from getting worse, but rarely resolve the condition. Prescription topical medications offer little advantage over OTC products and are prohibitively expensive. (Many of today’s OTC products were formerly prescrip tion medicines.) I don’t recom mend prescription fungal nail products due to high cost, low compliance and poor efficacy.

Alternaria is a fungus that causes onychomycosis

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